Each year, hundreds of millions of paraffin blocks are produced in histopathology laboratories [1], [2], [3]. In most cases, first small biopsies, the specimens must be properly oriented for diagnosis because the different tissue layers (e.g., the epithelial-stromal junction in skin and mucosal samples) have to be properly examined for assessment and/or staging of neoplastic, degenerative, or inflammatory diseases [1]. At grossing, the pathologist places and orientates the samples into the bio-cassettes; after processing in graded ethanol and appropriate reagents, the samples undergo paraffin-embedding. In many laboratories, this latter step is manually performed by trained technicians, and it may interfere with specimen orientation or even be at risk of cross-contamination and/or fragment loss in very small/thin samples that are difficult to visualize. Moreover, an incorrect orientation may require re-embedding the samples/s and re-cutting the slides with possible tissue waste or displacement.

For orientation/pre-embedding of small biopsies, various tools, including agar, cellulose filters, and protective sponges may be used in the pathology laboratories [4], [5], [6], [7], [8], [9], [10], [11]. In the last decade, automation of histopathological processes, including automated under-vacuum or microwave tissue processors, has been introduced in the daily working processes [12], [13], [14], [15]. Five years ago, an automated embedding system (Tissue-Tek AutoTec a120, Sakura Finetek BV) has been acquired in our Histopathology Laboratory. By using the provided sectionable cassettes, paraffin-embedded blocks are automatically obtained, without the manual embedding step. Recently, ready-to-use gels have been provided for tissue orientation during grossing procedures (Tissue-Tek Paraform Tissue Orientation Gels, Sakura Finetek BV). These gels are compatible with the processors, the automated embedding system, and microtomy [16], [17], [18].

This study aimed to assess the benefits and limits of using orientation Paraform gels and an automated embedding system for small biopsies in a high throughput pathology laboratory and their impact on the workload of technicians and pathologists.